The Miami Heat may be the most recognized name in town. But there is also another Heat team making headlines. The Health Care Fraud Prevention & Enforcement Action Team or HEAT is the Federal Government law enforcement arm meant to find criminals filing false Medicare claims. According to a recent report, Florida accounts for one third of Medicare Fraud across the nation and sadly enough, many of those criminals are located in South Florida. They are accused of siphoning resources meant to help some of our most vulnerable residents: our seniors.
During a one day bust in five major U.S. Cities, 94 people were charged, 25 of those in Miami-Dade County. One prominent Miami doctor is still at-large, apparently at a cruise vacation. The suspects presented $251 million in phony claims. Out of the $251 million, a mind boggling $103 million came from Miami-Dade. The illegal activities are not limited to bogus HIV/Aids clinics. The white collar crimes are expanding to mental health, physical therapy and other rehab services. The fraud crackdown was the main topic at the recent Miami Health Summit attended by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius.
What may happen next
Matters may get complicated for Florida when there is the prospect of having the future Governorship in the hands of Rick Scott, the former CEO of Columbia/HCA, whose private health corporation went through a rigorous 7-year FBI investigation. Between 2000 and 2003 the for-profit healthcare company paid a record $1.7 billion dollars in criminal and civil fines for Medicare fraud. After a June, 2010 in-depth report by the Miami Herald, Rick Scott defended his position on his web site by saying he would have corrected any problems at the company “immediately” had he known about them. However, experts point out to the lack of leadership. Florida’s Attorney General -now Republican candidate- Bill McCollum is desperately bringing that flaw to the forefront of his TV campaign ads against Scott. The results of that effort will only be known at the ballot box on August 24th.
Although what takes place in Tallahassee may feel far remove from city of Miami residents, the election of this coming Governor is crucial. The Governor is the only person in the State with the power to remove elected officials from office. During their respective tenures, Governors Jeb Bush and Charlie Crist suspended Commissioners Johnny Winton and Michelle Spence-Jones.
McCollum is having a hard time presenting his position to a public weary of career politicians and incumbents. And after three years in politics, Alex Sink, Florida’s CFO, still needs to increase her name recognition as a woman. However, she may have a card under her sleeve. The Democratic candidate for Governor wants to expand the whistle-blower act to also cover government employees who disclose government wrongdoing to the media. Something that Rick Scott may be totally against. A total of 30 whistle-blowers between company employees, doctors and contractors, came forward during the FBI probe into Columbia/HCA. At a campaign stop in Miami, Sink was not shy about her feelings towards Scott. “Voters have to realize what’s a stake here. One of the other candidates was the CEO of a company that over billed Medicare millions and millions of dollars.”
The “Everybody Does It” Syndrome
According to the Herald, other excuse presented by Rick Scott while CEO of Columbia/HCA was “we’re not doing anything different than anyone else in the healthcare industry is doing.” He also blamed the Clinton administration for going after him because of his opposition to healthcare reform in the 90’s.
Healthcare white collar crime broke another record in September 2009. Pfizer Inc. and its subsidiary Pharmacia & Upjohn Company Inc. agreed to pay $2.3 billion to resolve criminal and civil liability arising from the illegal promotion of certain pharmaceutical products. At the time acting Deputy Attorney General Gary Grindler stated “this is the largest health care fraud settlement in history; the largest criminal fine of any kind imposed in the U.S.; and the largest ever civil fraud settlement against a pharmaceutical company.”
Seniors with real needs left behind
Miami City Hall doesn’t deal directly with health issues. It doesn’t have a health agency of its own -that’s left to the County, State and Federal levels of government. But it is the city residents that are hurting the most. The less money there is to help senior citizens, the more it will affect the municipalities, specially in the city of Miami where a big percentage of seniors live and where many Senior Centers in Miami-Dade County are located. The more fraud in Medicare, the less money will trickle down to help local folks. At the end, whoever moves to the Governor’s Mansion in Tallahassee come 2011, will affect a City and County that has seen its share of medicare fraud criminals and elected officials in handcuffs.
More Medicare numbers:
The program, initiated in 1965, helps 43 million seniors and disabled Americans every year. Their yearly budget, $431 billion dollars or $10,000 per senior/disabled per year. As per 2009 estimates there are approximately 3.1 million seniors in Florida.
For more information visit: www.stopmedicarefraud.gov/